COPD Flashcards
What is bronchitis?
Inflammation of the lining of the bronchiole which narrows the airway
What is emphysema?
When the smaller alveoli collapse into larger air sacs
Is COPD fully reversible?
No
What are the main respiratory symptoms of COPD?
Breathlessness, cough and recurrent chest infection
What is the main cause of COPD?
Smoking
What non-respiratory systems are also associated with COPD?
Loss of muscle mass, weight loss, cardiac disease and depression/anxiety
What factors would make you suspect that a patient might have a COPD?
Age - over 35yrs, current or former smokers, chronic cough, breathlessness, sputum production, recurrent ‘winter’ bronchitis and wheeze or chest tightness
If a patient has nocturnal symptoms and conditions such as eczema or allergic rhinitis, is it more likely to be COPD or asthma?
Asthma
On examination what sort of signs might you see if the patient has a COPD?
Reduced chest expansion, prolonged expiration/wheeze, hyper inflated chest and possibly signs of respiratory failure
What are the signs of respiratory failure?
Tachypneoa (rapid breathing), Cyanosis (blue skin or lips), use of accessory muscles, pursed lip breathing and peripheral oedema
Why is spirometry used in when a COPD is suspected?
It can show an air obstruction which leads to a diagnosis and also determines the severity
Why is an ECG sometimes done in those with COPD?
To look for any cardiac compromise and heart failure
What non-pharmacological methods are used for the COPD management?
Smoking cessation, vaccinations, pulmonary rehabilitation, nutritional assessment and psychological support
What are the benefits of pharmacological management of COPD?
Relief of symptoms, prevention of exacerbations and improved quality of life
What different types of inhaled therapy are people with COPD given?
Short acting bronchodilators - SABA and SAMA
Long acting bronchodilators - LAMA or LABA
High dose inhaled corticosteroids (ICS) and LABA
At what point would a patient with COPD be put on long term oxygen?
If the arterial partial pressure drops below 7.3kPa or is between 7.3 - 8 kPa but the patient has nocturnal hypoxia, polycythaemia, pulmonary hypertension or peripheral oedema etc.
What symptoms would suggest an exacerbation of the COPD?
Increasing breathlessness, cough, increase in volume/purulence of sputum, wheeze and chest tightness
How would an acute exacerbation of COPD (AECOPD) be managed?
- Short acting bronchodilators (nebulisers if need be)
- Steroids - prednisolone
- Antibiotics - if signs of infection
- Hospital admission if unwell - tachypneoa, low oxygen sats (less than 90%), hypotension etc.
What investigations might be done if a patient is admitted to hospital with an acute exacerbation of their COPD?
- Full blood count –Biochemistry
- Glucose
- Theophylline conc.
- ABGs
- ECG
- Blood cultures
- Sputum microscopy, culture and sensitivity
Besides smoking, what causes COPD?
- Chronic asthma,
- Passive smoking
- Maternal smoking
- Air pollution
- Occupation
What is meant by 1 pack year?
1 pack of cigarettes every day for a year
What would you expect to see on a chest radiograph of a patient with emphysema?
Hyperinflated lung fields (>10 ribs posteriorly), flattened diaphragms, lucent lung fields and bullae
Name the investigations used to diagnose COPD
- Spirometry
- CXR
- ECG
- FBC
- BMI
- AIAT (if under fifty years)
Name the complications of COPD
- Acute exacerbation
- Pneumonia
- Macro-nutrient deficiency
- Wasting
- Muscle Atrophy
- Polycythemia
- Pulmonary hypertension
- Cor pulmonale
- Depression
- Pneumothorax
How would an acute exacerbation of COPD be managed on the wards?
- Target sats of 88-92%
- Nebulised bronchodilators
- Corticosteroids
- Antibiotics
- Assessing for evidence of respiratory failure
Name the causes of COPD not attributed to smokin
- Chronic asthma
- Passive smoking
- Maternal smoking
- Air pollution
- Occupation
What is the function of a1-antitrypsin?
It neutralises enzymes released by neutrophils
List the potential differentials for COPD
- Asthma
- Lung cancer
- Left ventricular failure
- Fibrosing alveolitis
- Bronchiectasis
- Rare: TB and recurrent pulmonary emboli
What features on a CXR would suggest COPD
- Hyperinflated lung fields (>10 posterior ribs)
- Flattened diaphragms
- Lucent lung fields
- Bullae
What would an FBC show in a patient with COPD?
Secondary polycythaemia
What might an ECG show in a patient with COPD?
- Right axis deviation
- P pulmonale
- T wave inversion V1-4
List the clinical features of an acute exacerbation of COPD
- Increased cough and sputum
- Increased SOB
- Wheeze
- Oedema
- Confusion
- Drowsiness
- Cyanosis
- Flapping tremor
- Pyrexia
Which investigations would you order for an acute exacerbation of COPD
- CXR
- Blood gases
- FBC
- U&Es
- Sputum culture
How can an acute exacerbation of COPD be managed
- Nebulised bronchodilator B2 and anti-muscarinic
- O2
- Oral/IV corticosteroid
- Antibiotics
- Diuretics
- IV aminophylline
- Respiratory stimulant
- NIV
